One-Lung Ventilation Calls for One-Lung Recruitment

Anaesthetic management of intraoperative tracheo-bronchial injury

Intraoperative tracheobronchial injury (TBI) may manifest clinically as pneumothorax, pneumomediastinum, subcutaneous emphysema, cyanosis, and respiratory insufficiency and has serious implications if it remains undetected or is managed improperly. The outcome of such injuries is affected by the extent of the lesion, pulmonary status & the surgical reconstruction undertaken. The recommended airway management of an intraoperative tracheal tear is to bypass the injured side by intubating the healthy bronchus with a single lumen endotracheal tube (ETT) and the use of a bronchial blocker or double lumen endotracheal tube (DLT) and becomes a very challenging situation.

We report successful anaesthetic management of an accidental traumatic rupture of the left main bronchus during surgical dissection in an elderly lady of Carcinoma Oesophagus who underwent a Video Assisted Thoracoscopic surgery (VATS), and was managed by one lung ventilation of the contralateral (right) side manipulating the same DLT and lung protective ventilation.

Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and Postoperative

Mechanical ventilation of patients undergoing thoracic surgery is often challenging. These patients frequently have significant underlying comorbidities, including cardiopulmonary disease, and often must undergo 1-lung ventilation. Perioperative respiratory complications are common and are multifactorial in etiology. Increasing evidence suggests that mechanical ventilation is associated with, and may even cause, lung damage in both sick and healthy patients. Gas exchange to provide acceptable end-organ oxygenation remains a primary goal but so too is minimization of risks for acute lung injury. Every ventilator strategy is associated with potential beneficial and adverse side effects. Understanding the impact of various ventilation strategies allows clinicians to provide optimal care for patients.